| Doctor Name: | DR. RYAN THOMAS MACKEY |
| NPI Number: | 1295982668 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 972-25 |
| Business Practice Address: | 1001 W Main St Waupun, WI - 539631601 |
| Business Phone Number: | 9203613063 |
| Business Fax Number: | 9203617317 |
| Mailing Address: | 1001 W Main St, WAUPUN |
| State: | WI |
| Postal Code: | 539631601 |
| Phone Number: | 9203249301 |
| Fax Number: | 9203249473 |
| NPI Enumeration Date: | 08/27/2008 |
| NPI Last Update Date: | 11/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 972-25 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |